Adel Alhaj Saleh, MD, MRCS, Amir H Aryaie, MD, FACS. Texas Tech University Health Sciences Center
- A 65 year-old female with a history of hysterectomy for endometrial cancer and radiation in 2008.
- Developed bladder prolapse but did not undergo suspernsionprocedure.
- Had urinary urgency and feeling of non empty bladder for 2-3 week for that she wanted to visit Uro/GYN clinic for evaluation.
- One night before the clinic visit she douched and felt something coming out of her vagina.
Medical History
- DM2
- Charcot foot
- HTN
- Multiple abscesses with poor wound healing.
Surgical History
- C/S*1, radical hysterectomy , Lt above knee amputation.
- Open appendectomy and cholecystectomy.
- I&D of abdominal wall abscess
- PV exam showed omentumand bowel in the vagina
- The vaginal opening was plugged with a bulb by the OB/GYN team.
- CT scan of the abdomen showed dehiscence of vaginal cuff
The patient was then planned to
- Laparoscopic Perineal Hernia Repair in lithotomy position.
Post-operative Course
- Patient was discharged on POD #5 after making sure she could void with no issues.
- Followed up by OBGYN in the Clinic
- Once again referred to us because she wanted to do sleeve gastrectomy (BMI 35 kg/m2 with multiple comorbidities)
- The patient underwent Laparoscopic Sleeve gastrectomy, 6 months after the perineal hernia repair.
- During the procedure, pelvic floor was inspected, the ACELL mesh is holding well in place, and no abdominal content herniating to the pelvis
In Conclusion
- Laparoscopic repair of perineal hernia with ACELL mesh is safe and feasible even if the patient had multiple abdominal procedures before.
- Acelluarmatrix porcine mesh is durable and provides good support to the pelvic floor.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96046
Program Number: V282
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop